Multidimensional assessment of voice quality of future elite vocal performers

Abstract

Introduction and objective: This study correlates the Singing Voice Handicap Index (SVHI) scores with videostrobolaryngoscopy and acoustic analysis in healthy professional singers, as a measure of self-perceived vocal health, versus actual pathology diagnosed during examination by stroboscopy, or by modification at the acoustic voice evaluation. The objectives of the study were to measure the strength of self-assessment among professional singers and to determine whether there is a benefit of combining SVHI, acoustic analysis and videostrobolaryngoscopy for the routine assessment of singers who have no obvious singing voice problem. Method: Prospective cross-sectional study. The voice quality of 40 students of the Music Academy, Cluj-Napoca, was assessed by means of a multidimensional test battery containing a singing voice handicap index (SVHI), as well as SVHI-10, videolaryngostroboscopy, maximum phonation time on vowel /a/, S/Z ratio, Jitter, Shimmer and NHR (Harmonic Noise Ratio, at lowest, highest and conversational frequency). Additionally, in a questionnaire on daily habits has been recorded for the participants, covering the prevalence of smoking, eating habits, and vocal abuse. The correlation between SVHI scores, acoustic analysis and pathologic findings seen on videostrobolaryngoscopy was analyzed using linear regression and serial t tests to draw the conclusions of this study. Results: Both SVHI and SVHI-10 scores showed, as previously expected, normal values for healthy singers (SVHI-10 being the singers preferred metric). However, although all participants self-identified as healthy, laryngeal abnormalities were relatively common. Acoustic analysis of students voices identified relative instability of pitches, problems with F0 variation, TMF (Maximum Phonation Time) and S/Z ratio. No Significant correlation (P = 0.9501) between SVHI scores, acoustic analysis and videostrobolaryngoscopy findings were shown by the linear regression analysis. Conclusions: Multidimensional assessment of voice quality for the routine evaluation of singers without obvious singing voice problems is an important tool for the early detection of voice problems, despite appearances of a healthy voice. A trained singer has the possibility to compensate minor laryngeal modifications using singing techniques and, thus, is at risk of overlooking or ignoring an existing pathology. In conclusion, acoustic evaluation of the performers’ voices through the methods outlined above could assist in early detection and treatment of vocal pathology.